Advertisement

Annals of Surgical Oncology

, Volume 21, Issue 5, pp 1480–1486 | Cite as

Repeat Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy May Offer Survival Benefit for Intraperitoneal Mesothelioma: A Single Institution Experience

  • Joyce Wong
  • Abigail L. Koch
  • Jeremiah L. Deneve
  • William Fulp
  • Tawee Tanvetyanon
  • Sophie Dessureault
Regional Cancer Therapies

Abstract

Introduction

Cytoreduction with heated intraperitoneal chemotherapy (HIPEC) has demonstrated improved overall survival (OS) in malignant peritoneal mesothelioma (MPM). The role of repeated HIPEC for MPM is less clear.

Methods

An institutional review board-approved database of MPM patients was analyzed for clinical factors and outcomes.

Results

From June 2004 to March 2012, 29 patients underwent surgical treatment for mesothelioma. HIPEC was aborted in 3 and completed in 26; 8 underwent additional repeat HIPEC. The majority was male (62 %), median age 66 years. There was no significant difference in surgery duration, blood loss, or hospital-stay-duration between initial and repeat HIPEC. Cisplatin was the chemotherapy used. Complications occurred in 17 (65 %) initial and 6 (50 %) repeat HIPEC, with wound complications being most common. Reoperation was less common (4 % initial and 25 % repeat), and perioperative death was rare (4 % initial, 0 % repeat). Fourteen (54 %) initial and seven (58 %) repeat HIPEC patients received adjuvant chemotherapy. Median time from HIPEC to initiation of chemotherapy was not different between initial and repeat HIPEC (8.8 and 4.6 months, respectively, p = 0.68). Median treatment-free time (time from initial to repeat HIPEC or chemotherapy) also was not different between initial and repeat HIPEC (8.8 and 6.3 months, respectively, p = 0.92). Median OS for the cohort was 41.2 months. Patients who underwent repeat HIPEC had improved median OS (80 months) versus single HIPEC (27.2 months; p = 0.007). A lower peritoneal carcinoma index and complete cytoreduction were associated positively with OS.

Conclusions

Cytoreduction and HIPEC for MPM are associated with longer OS. Patients who are candidates for repeat HIPEC may derive an even greater OS advantage.

Keywords

Overall Survival Median Overall Survival Pemetrexed Peritoneal Carcinoma Index Peritoneal Mesothelioma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Robinson BWS, Lake RA. Advances in malignant mesothelioma. N Engl J Med. 2005;353:1591–603.PubMedCrossRefGoogle Scholar
  2. 2.
    Delgermaa V, Takahashi K, Park EK, et al. Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008. Bull World Health Organ. 2011;89:716–24C.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Turner K, Varghese S, Alexander HR Jr. Current concepts in the evaluation and treatment of patients with diffuse malignant peritoneal mesothelioma. J Natl Compr Canc Netw. 2012;10(1):49–57.PubMedGoogle Scholar
  4. 4.
    Yan TD, Deraco M, Elias D, et al. A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database. Cancer. 2011;117(9):1855–63.PubMedCrossRefGoogle Scholar
  5. 5.
    Janne PA, Wozniak AJ, Belani CP, et al. Open-label study of pemetrexed alone or in combination with cisplatin for the treatment of patients with peritoneal mesothelioma: outcomes of an expanded access program. Clin Lung Cancer. 2005;7:40–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Simon GR, Verschraegen CF, Janne PA, et al. Pemetrexed plus gemcitabine as first-line chemotherapy for patients with peritoneal mesothelioma: final report of a phase II trial. J Clin Oncol. 2008;26:3567–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Sebbag G, Yan H, Shmookler BM, et al. Results of treatment of 33 patients with peritoneal mesothelioma. Br J Surg. 2000;87:1587–93.PubMedCrossRefGoogle Scholar
  8. 8.
    Yan TD, Deraco M, Baratti D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27:6237–42.PubMedCrossRefGoogle Scholar
  9. 9.
    Glehen O, Gilly FN, Boutitie F, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. A multi-institutional study of 1290 patients. Cancer. 2010;116:5608–18.PubMedCrossRefGoogle Scholar
  10. 10.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.PubMedCrossRefGoogle Scholar
  11. 11.
    Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22(16):3284–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Chua TC, Moran BJ, Sugarbaker PH, et al. Early-and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–56.PubMedCrossRefGoogle Scholar
  13. 13.
    Zang RY, Harter P, Chi DS, et al. Predictors of survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery based on the pooled analysis of an international collaborative cohort. Br J Cancer. 2011;105(7):890–6.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Parson EN, Lentz S, Russell G, et al. Outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface dissemination from ovarian neoplasms. Am J Surg. 2011;202(4):481–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Yu W, Whang I, Chung HY, et al. Indications for early postoperative intraperitoneal chemotherapy of advanced gastric cancer: results of a prospective randomized trial. World J Surg. 2001;25(8):985–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Yu W, Whang I, Suh I, et al. Prospective randomized trial of early postoperative intraperitoneal chemotherapy as an adjuvant to resectable gastric cancer. Ann Surg. 1998;228:347–54.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Mcconnell YJ, Mack LA, Francis WP, et al. HIPEC + EPIC versus HIPEC-alone: differences in major complications following cytoreduction surgery for peritoneal malignancy. J Surg Oncol. 2012;107(6):591–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Sugarbaker PH, Yan TD, Yoo SD. Comprehensive management of diffuse malignant peritoneal mesothelioma. Eur J Surg Oncol. 2006;32(6):686–91.PubMedCrossRefGoogle Scholar
  19. 19.
    Averbach AM, Sugarbaker PH. Peritoneal mesothelioma: treatment approach based on natural history. Cancer Treat Res. 1996;81:193–211.PubMedCrossRefGoogle Scholar
  20. 20.
    Yano H, Moran BJ, Cecil TD, Murphy EM. Cytoreductive surgery and intraperitoneal chemotherapy for peritoneal mesothelioma. Eur J Surg Oncol. 2009;35(9):980–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Feldman AL, Libutti SK, Pinkpank JF, et al. Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. J Clin Oncol. 2003;21(24):4560–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Van Sweringen HL, Hanseman DJ, Ahmad SA, et al. Predictors of survival in patients with high-grade peritoneal metastases undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Surgery. 2012;152(4):617–24.PubMedCrossRefGoogle Scholar
  23. 23.
    Omohwo C, Nieroda CA, Studeman KD, et al. Complete cytoreduction offers longterm survival in patients with peritoneal carcinomatosis from appendiceal tumors of unfavorable histology. J Am Coll Surg. 2009;209(3):308–12.PubMedCrossRefGoogle Scholar
  24. 24.
    Cavaliere F, De Simone M, Virzi S, et al. Prognostic factors and oncologic outcome in 146 patients with colorectal peritoneal carcinomatosis treated with cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: Italian multicenter study S.I.T.I.L.O. Eur J Surg Oncol. 2011;37(2):148–54.PubMedCrossRefGoogle Scholar
  25. 25.
    Golse N, Bakrin N, Passot G, et al. Iterative procedures combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal recurrence: postoperative and long-term results. J Surg Oncol. 2012;106:197–203.PubMedCrossRefGoogle Scholar
  26. 26.
    Votanopoulos KI, Ihemelandu C, Shen P, et al. Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy. J Am Coll Surg. 2012;215:412–7.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Joyce Wong
    • 1
  • Abigail L. Koch
    • 1
  • Jeremiah L. Deneve
    • 1
  • William Fulp
    • 2
  • Tawee Tanvetyanon
    • 3
  • Sophie Dessureault
    • 1
  1. 1.Department of Gastrointestinal OncologyMoffitt Cancer CenterTampaUSA
  2. 2.Department of BiostatisticsMoffitt Cancer CenterTampaUSA
  3. 3.Department of Thoracic OncologyMoffitt Cancer CenterTampaUSA

Personalised recommendations